GIDS being sued by their safeguarding lead.

(need to step away for 30 mins)

(my note - and the nit-picky grilling of which emails Sonia replied to shows a weak defence imo)

(my note - my interpretation is that their digital services, IT systems, operations, processes and/or the use of them, was not fit for purpose. As a result serious complicated safeguarding concerns were not captured, communicated or acted upon)

(my note - it's quite a stretch of the imagination to suggest that a social worker should be responsible for operations, processes, IT-systems, record keeping and communication across multiple agencies)

YG again questions why, given her raising of concerns for a year, SA didn't write to Sally Hodges to say she was pleased with email to gids

Haha who does this? And if she had, wouldn't that be twisted to look like she 'had an agenda'?

SA clarifies she thought response from SH and PC was robust and told Dr Bell it was a v good response; that they understood it was their responsibility to deal with the challenges...

...He had asked whether she would join him in writing to gids staff to say they could speak to them at any time and she thought that 'provocative'.

YG again questions why, given her raising of concerns for a year, SA didn't write to Sally Hodges to say she was pleased with email to gids
SA: "i don't ordinarily send congratulatory emails to someone who does something that it required" ...

...but that is not to suggest i wasn't supportive.

YG - what i'm concerned about is that you don't appear to respond to dr hodges in a collegiate way and instead you respond to dr bell to critique the email communication... i wonder why you thought that the course to take rather than lending support to dr hodges?

SA - dr hodges was already very aware - and i want to make it v clear - that i was as supportive as i could be within my role... and i was v pleased that dr hodges and dr carmichael had the foresight to alert the CEO...

...the fact that Dr bell then wrote to me and i responded is no indication of disregard for dr hodges. she actually says pointedly to Dr bell that she is aware of my help and is grateful for it and makes the point that I am keeping her abreast of concerns...

...To read into that that i was disregarding of Dr hodges and dr Carmichael's involvement is frankly unhelpful.

YG now on July 2018 - proposed meeting with Dr Bell, Polly Carmichael and SA. YG suggests that PC felt blind-sided...

SA - the suggestion is that somehow i was acting as an intermediary for Dr Bell. If anyone wanted to find out from Dr Bell what he was doing then surely they'd be best to follow up with him?

YG cites email (just mentioned) from Sally Hodges and PC to gids staff. Do you respond to Dr Hodges given you'd been so involved in raising the concerns?

SA - I can't remember whether i did or didn't but what i was v pleased to see was that Dr Hodges... and Dr C, given they'd co-written the response, was that they'd copied in the CEO to the email correspondence which wld lend a great deal of authority, which i was v pleased about

SA - i believe that Dr C and Dr H wrote to the gids service seeking both of them to bring about a multi-pronged form of remedy... at that time i was doing my very best to make sure the right people were involved in this conversation...

I had learned from the previous autumn that this wasn't just a matter for safeguarding, but needed involvement from all key stakeholders in the organisation, and frankly it was like trying to herd cats. Solution to complicated, serious situations does not happen overnight...

SA - "I was trying to engage the organisation to understand the magnitude of difficulties."

(446/7/8) YG brings up s/g audit from May 2018 and then meeting in June, which results in some action points. With the exception of Dr Senior having a conversation with Sally, it seems to me these are all external things, rather than involving the service

SA - i can see that and i think i've made clear this was a very complicated scenario that i could not solve by myself. It was likely it would result in something transformational happening to the service...

...but what i was doing was meeting with Garry, and these were by this point in the presence of Sally Hodges, and also included Dr C... there were some very basic s/g issues that we needed to attend to

YG - Dr R's recall is that there were meetings but they were about other things, than specifically about trying to come up with an action plan

Found that GIDS wasn't correctly using the trust's care notes system (electronic record) and instead using their own form, and this posed a problem.

The CQC assessment of Tavistock GIDS service in January 2021 identified serious problems with record keeping

The Inspection report is damning. Inspectors found:

Staff did not always manage risk well. Many of the young people waiting for or receiving a service were vulnerable and at risk of self-harm. The size of the waiting list meant that staff were unable to proactively manage the risks to patients waiting for a first appointment.
For those young people receiving a service, individual assessments were not always in place with plans for how to manage risks.
Staff had not consistently recorded the competency, capacity and consent of patients referred for medical treatment before January 2020.
Staff did not develop all-inclusive care plans for young people.
Records of clinical sessions did not include any structured plans for care or further action.
Staff did not fully record the reasons for their clinical decisions in case notes. There were significant variations in the clinical approach of professionals in the team and it was not possible to clearly understand from the records why these decisions had been made.
www.transgendertrend.com/care-quality-commission-inspection-gids-inadequate/

A woman's place is in the wrong.

Right - I'm really beginning to understand this now!

GIDS don't use 'Care Notes' that can be shared between depts, social services and the patients local CAMHS. So there's no record of concerns being linked - presumably because it's 'transphobic' to link anything social or mental health to gender dysphoria??

When it was pointed out they should be doing care notes GIDS got all 'That's so transphobic'. Now retrospectively, SA should've fixed it all for them, and told them in a more friendly way, not a grumpy way, because that's not nice.

YG - then you didn't look...
SA - i didn't look specifically at GIDS - was looking at the child and adolescent dept as a whole...

SA - "unless i have concerns, as i said yesterday, i would be giving the board an overview. if a had specific concerns about a service i would bring that to the attention of the medical director and the medical director sits on the board

YG - this is actually quite a worrying revelation:you didn't know what the state of play was in gids. You produce a report that to the reasonable observer is read as the use of care notes has improved.

SA - i don't agree. it would be different if i was segmenting every service in the trust

Hannah Barnes @hannahsbee

• - Back to 2017 - -

(1080 bundle - this is actually 2018 - v hard to follow)
YG cites safeguarding report for 2017/18 which indicates that things have improved i terms of s/g reporting...

SA establishes that exec summary is written by Dr Senior, plus the report refers to April 2017 to March 2018, 'my point being that it was not until june 2018 that i became aware that there was a sig problem'...

... in terms of ordinary practice not happening in the gids service - that they were not recording s/g referrals using the system we would use to collect data

SA - my concern was yes i could help them with the s/g matter, but it wasn't my clinical responsibility to sort other aspects, which needed urgent attention before the clinician left and i wanted to make that clear;

i had assisted in terms of the s/g concern and it was a chronic concern that the local authority was aware of so no need for a referral - i was trying to help a colleague who says she is having difficulty in tying this down

SA - you say i was discourteous to mr richardson. i dispute that. What i saw there were clinicians who were really worried, said they were running out of time, we need to speak to our line manager. can you help? I'm suggesting that leaving it until the last minute was unhelpful;

that's why the workers came to me. But there were issues that were rightly better addressed by Mr Richardson. I was not trying to be discourteous but felt there needed to be line drawn between his managerial responsibilities and mine.

SA - i think that was a date already in the diary for the two workers. wider context was that one of these workers was leaving the service and that was their meeting with Mr R to wind down their work and discuss...

YG - so why are you asking GR for his availability?
SA - i need to read the trail completely... i did not arrange a meeting, i'm just qualifying that there was a meeting already set up...

i didn't know whether it was a good idea for me to attend because, i believe, the meeting was already in hand and was discussing other issues as well as the case in hand
YG - if you'll forgive me i think that is a reconstruction... i think you must be wrong about the 31st...

YG says email trail betw GR and SA suggests that the tone and content is really quite disrespectful to another colleague who is trying to work out a potential child protection matter.

SA - i had a meeting with sally hodges and garry richardson in august 2018 and discussed that the system they were using was unlikely to be able to evidence the work they were doing...

dr hodges said that she believed that taking the s/g fwd woudl be best to occur in late October because there were a number of 'manifest issues' that needed to be addressed in the interim. And it was obvious she was right about that

YG - I've asked you a number of times why mr richardson is left out of emails and suggested that you thought little of him, which you didn't agree with...

YG - (P509 - looking at emails from May 2019) - you receive a referral (from gids staff), you copy in GR, you set up a meeting with them on 31st May

Found that GIDS wasn't correctly using the trust's care notes system (electronic record) and instead using their own form, and this posed a problem.

YG - i'm not suggesting it wasn't a problem, but was a trust wide problem. What did you do positively to work with GIDs to remedy that?

SA - yes there were trust-wide problems, but completely different issue: GIDS were not even trying to use care notes, but instead were using their own forms.

YG - what did you do to work with gids to help them and make sure they were using the recommended system?

YG - i don't see that there is any action that you're proposing to take to work with gids or dr hodges to work on s/g issues - if that was your concern

SA - i basically say that i'm currently conducting a further audit ... so trying to take fwd both the number of children being referred to social care and the assurance in terms of s/g that's taking place

YG - do you see why a further audit might appear to be critical, rather than seeking to help the service?

SA - i see what you're saying but don't agree. I don't see audit as frightening or intrusive. when dr hodges asks are we referring children to social care where there are known risks, how would we know that unless we are scrutinising our own records?. One can't do it anecdotally

I don't know whether or not Sonia will win - I expect she has to prove she received detrimental treatment because of her raising of these issues - but the evidence is getting important stuff out into the public domain. I hope it all gets written up in the judgement,and informs the Cass review.

One thing that struck me yesterday - polly carmichael was said to have become tearful when the model was raised. What would that mean - what do they mean by model and why would she be upset at someone raising it (presumably it was being criticised)?

Audit had shown that in the last financial year GIDS had made 10 referrals and my baseline was that that seemed low in comparison to other service.

Previous evidence given,

AS: no problem at all with day to day supervision/line management from GR. just when it came to complex cases

AS: recurring theme in his supervision with Garry Richardson was don’t go to social care because they won’t know what to do with cases involving gender identity

WHY should safeguarding not be 'comparable' in all services?!!!

I don't think YA is suggesting that you can't make a comparison between GIDS and other services here. Just that you might not expect the rate of SG referrals to be the same as other services.

You might expect a GP service too have a lower rate (corrected for caseload volume) than a specialist CAMHS service for example.

I think Dr Hilary Cass ought to be VERY concerned about the nature and manner of the Tavistock's defence here.